Fernández-Espejo Lab

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UNIVERSITY OF BIRMINGHAM, ENGLAND

NEURAL BASES OF DISORDERS OF CONSCIOUSNESS

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At the moment, there are not effective therapeutic options available for patients in a VS, regardless of the level of cognitive function each patient may retain. We are assessing the potential for a noninvasive form of electrical brain stimulation (i.e. transcranial direct current stimulation –tDCS) to provide VS patients with a degree of control over their external behaviour, which would give them a physical means of interacting with the world for the first time since their injuries. This line is currently funded by the MRC (New Investigator Research Grant),

as well as by funding from the University of Birmingham and the Wellington Hospital for

CLINICAL BIOMARKERS

INTERVENTIONS

We are interested in the functional and structural bases of consciousness and its disorders. Specifically, we use magnetic resonance imaging (MRI) to study patients who are in a vegetative state (VS), or related disorders of consciousness such as the minimally conscious state, or coma, after suffering severe brain injury. Patients in a VS are awake but do not show any behavioural sign of awareness. Nevertheless recent fMRI studies have demonstrated that some of these patients may retain higher cognitive functioning than that they are able to show behaviourally. We combine diffusion weighted imaging and functional MRI to study how damage to specific regions of the brain can generate the particular patterns of impaired or preserved cognitive function each patient exhibits. Finally, we use tDCS to establish causal links between specific brain networks and awareness.

The diagnosis of VS patients is currently made solely on the basis of subjectively observed behaviour, with a known error rate of over 40%. We work to develop objective structural MRI markers that can be used in the clinical settings, with the final goal of reducing misdianosis in this population. In parallel, we aim to identify early prognostic biomakers that can assist the clinician when making important decisions about allocation of resources, and continuation (or otherwise) of medical care.

This line is supported by a collaboration agreement between our research group and the Wellington Hospital.